A Tale of 3 Asian Cities: How is Primary Care Responding to COVID-19 in Hong Kong, Singapore, and Beijing.

Hong Kong, Singapore, and Beijing have some of the highest numbers of international arrivals and densest living spaces globally, yet these cities have reported low numbers of deaths amid the coronavirus disease 2019 (COVID-19) outbreak. Primary care has played different roles in each of the health systems in combatting the pandemic. Both Hong Kong and Singapore have a 2-tiered health system with the majority of primary care provided in the private sector. The primary care system in Beijing consists of community health facilities, township health centers, and village clinics. The role of primary care in Hong Kong includes using the public primary care clinics as part of an enhanced surveillance program together with accident and emergency departments, as well as triaging patients with suspected infection to hospitals. Singapore's response to COVID-19 has included close cooperation between redeveloped polyclinics and private and public health preparedness clinics to provide screening with swab tests for suspected cases in the primary care setting. Beijing's unique response has consisted of using online platforms for general practitioners to facilitate monitoring among community residents, as well as public health education and a mobilized pharmacy refill program to reduce risk of transmission. Established challenges, however, include shortages of personal protective equipment and the heavy workload for health care staff. Regardless, all 3 cities have demonstrated enhanced preparedness since experiencing the severe acute respiratory syndrome epidemic, and the responses of their primary care systems therefore may offer learning points for other countries during the COVID-19 pandemic.

Stress, culture and 'home': social context in Turkish and Arabic-speaking Australians' views of diabetes prevention.

ISSUE ADDRESSED: A high prevalence of type 2 diabetes and diabetes risk factors exists among Middle East-born communities, largely attributed to modifiable lifestyle factors. Understanding the interplay between individual behaviour and societal and environmental factors would assist in planning interventions to reduce diabetes prevalence in these groups. This study explores the knowledge, attitudes and perceptions of diabetes and its prevention in Turkish and Arabic-speaking communities in metropolitan Melbourne, Victoria, Australia. METHOD: Turkish and Arabic-speaking people with risk factors of developing diabetes were invited to attend focus groups. Discussions were audiotaped and transcribed with the assistance of interpreters and then analysed by two researchers independently to ensure validity. Common themes were drawn upon and reported. RESULTS: Fifty-two people (41 females and 11 males, mean age=58.8 years) participated in five focus groups. Understanding of diabetes and potential for reducing risk of diabetes is closely linked to social context. Individual behaviours around diet and exercise, while partly influenced by cultural factors, are framed by concerns about public safety and food quality, which are themselves closely linked to experiences of social exclusion and marginalisation. CONCLUSION: These factors limit potential for individual behaviour change and are implicated in the way chronic stress acts as a common pathway through which individual health comes to embody social context.

The inverse care law revisited: impact of disadvantaged location on accessing longer GP consultation times.

OBJECTIVE: To compare the rate of provision of longer consultations per head of population across practice locations categorised by socioeconomic status. DESIGN: Retrospective analysis of Medicare data for all consultations for all general practitioners in Australia for the 1998-99 and 1999-2000 financial years, grouped by postcode of practice location. Postcodes were categorised by the Socio-Economic Indexes for Areas, Index of Relative Socio-Economic Disadvantage score. MAIN OUTCOME MEASURES: Number of consultations and number of brief, standard, long and prolonged consultations per capita in each postcode grouping. RESULTS: The absolute number of long plus prolonged consultations showed no trend across postcode groups, but the rate ratio per person was significantly higher in more advantaged postcode areas. This represents an example of care provision in inverse relationship to need. DISCUSSION: Despite higher rates of chronic disease and lower rates of preventive care uptake, patients in low socioeconomic status areas receive longer GP consultations at a lower rate than patients in more advantaged areas. Possible strategies to overcome this inverse care provision include increased numbers of GPs in disadvantaged communities, removal of financial disincentives to longer consultations, and strengthening health promotion and community health services in disadvantaged areas.